True Stories of Imaginary Illness

A neurologist’s insightful and compassionate look into the misunderstood world of psychosomatic disorders, told through individual case histories

It’s happened to all of us: our cheeks flush red when we say the wrong thing, or our hearts skip a beat when a certain someone walks by. But few of us realize how much more dramatic and extreme our bodies’ reactions to emotions can be. Many people who see their doctor have medically unexplained symptoms, and in the vast majority of these cases, a psychosomatic cause is suspected. And yet, the diagnosis of a psychosomatic disorder can make a patient feel dismissed as a hypochondriac, a faker, or just plain crazy.

In Is It All in Your Head? neurologist Suzanne O’Sullivan, MD, takes us on a journey through the world of psychosomatic illness, where we meet patients such as Rachel, a promising young dancer now housebound by chronic fatigue syndrome, and Mary, whose memory loss may be her mind’s way of protecting her from remembering her husband’s abuse. O’Sullivan reveals the hidden stresses behind their mysterious symptoms, approaching a sensitive topic with patience and understanding. She addresses the taboos surrounding psychosomatic disorders, teaching us that “it’s all in your head” doesn’t mean that something isn’t real, as the body is often the stand-in for the mind when the latter doesn’t possess the tools to put words to its sorrow. She encourages us to look with compassion at the ways in which our brains act out, and to question our failure to credit the intimate connection between mind and body.

Excerpt from Is It All in Your Head?

First I went to see Pauline. Mark and her mother were present, positioned as sentinels once again.

“How dare you say that all her medical problems are psychological? The only distress Pauline has ever had in her life has been because of her illness. If these convulsions are due to madness, it all comes from the pain she has suffered. Did you ever think of that?” said Mark.

It occurred to me for the first time that there could be things that Mark did not know.

“I’m sorry this has been so difficult. I know there are points on which we don’t agree so I think it would be more useful to Pauline if we stick to addressing those things that are definite.”

“Pauline needs to pass a catheter to empty her bladder. That’s definite. How could that be psychological?” A little spray of spittle accompanied Mark’s words. Pauline’s and her mother’s eyes were cast downwards.

“We can’t unravel all of this here and now.” I turned to Pauline. “Pauline, I don’t have all the answers but I know one thing, and that is that your convulsions did not occur as a result of a brain disease. That is what I know for certain and that is where I think we should focus our attention.”

The room fell completely silent. Pauline would not look at me. Her eyes were fixed on Mark, who was gripping her hand. I looked at how their fingers intertwined. I could hardly tell one hand from the other, and I thought of my discussion with the psychiatrist. Here was a young woman who had, in a sense, lost one side of her family, and now illness bound her tightly to those who remained. I thought of her threat to harm herself and saw a girl who knew only one way to be heard.

“O’Sullivan illuminates one of medicine’s most fraught moments, when a physician reaches the conclusion that there is no physical (or ‘organic’) disease.” —New York Review of Books

“In this important book, O’Sullivan…advocates for new ways to look, understand, and treat unexplainable symptoms, paving the way for bringing relief to her patients. Some of the cases will break your heart.” —Huffington Post

“Each chapter of this book presents a case study, lending vivid life to patients with psychosomatic disorders, along with extensive context for everything including the bygone diagnosis of ‘hysteria’ and the dawn of neurology as a medical profession….If empathy is bolstered by understanding, then this book will bring such sentiments to a rarely understood condition. It will engage readers’ heads, but also quite possibly enter their hearts.” —Publishers Weekly

“Doctors’ tales of their patients’ weirder afflictions have been popular since Oliver Sacks . . . Few of them, however, are as bizarre or unsettling as those described in this extraordinary and extraordinarily compassionate book.” —James McConnachie, Sunday Times

“An important study of psychosomatic illness, which shows it to be a serious disease of modern society: misunderstood, misdiagnosed, and surrounded by fear.” —Louise Carpenter, The Telegraph

“Honest, fascinating, and necessary.” —David Aaronovitch, The Times (UK)

“A fascinating glimpse into the human condition . . . a forceful call for society to be more open about such suffering.” —Ian Birrell, Daily Mail

Questions for discussion

Before reading Is It All in Your Head, did you know anything about psychogenic disorders, or about physical responses to emotional stimuli more generally? What did you learn that you didn’t know before? What surprised you?

O’Sullivan emphasizes the importance of believing her patients–of acknowledging that their physical pain is in fact real, even though she believes it to have a psychological origin. Do you believe them? If you were in O’Sullivan’s place, what would it take to convince you that your patient isn’t “faking it”?

Even after rigorous medical testing, most of O’Sullivan’s patients are initially reluctant to accept her diagnosis of a psychogenic disorder. Why do you think that is? How do you think you would react to such a diagnosis?

Have you ever experienced a psychosomatic illness or affliction? How did you know that it was mental rather than physical?

What did you think of O’Sullivan’s relationship with her patients? Does her experience and understanding of psychogenic disorders make it easier or harder for them to accept her diagnoses?

Were there any particular patients in Is It All in Your Head? that you could relate to? Who? Why?

The absence of a definitive medical cause of illness or pain does not prove that it is “all in your head.” If you were one of O’Sullivan’s patients, what would it take to convince you that your symptoms might stem from psychological trauma rather than physical trauma?

Do you agree with O’Sullivan that a stigma exists against sufferers of psychogenic illness or pain? Has reading Is It All in Your Head? changed the way you think about these disorders and those who suffer from them?